Flashcards in Monday, 2-27-Pap smear, cervical dysplasia, and cancer (Wootton) Deck (18):
site where greater than 90% of cervical neoplasias arise?
the majority of cervical cancers and CIN are caused by these HPVs?
HPV 16 and 18 responsible for ~70% of cervical CA
Risk factors for cervical neoplasia?
-more than 1 sexual partner or male sexual partner who has had sex with >1 person
-young age at 1st intercourse or pregnancy
-infrequent or absent pap screening tests
PAP screening guidelines for under 21 yrs?
PAP screening guidelines for age 21-29?
cytology alone every 3 yrs
PAP screening guidelines for ages 30-65?
HPV and cytology "cotesting" every 5 yrs (preferred)
PAP screening guidelines for 65+?
no screening following adequate negative prior screening
PAP screening after hysterectomy?
what is the next step in management of Atypical Squamous cells of undetermined significance (ASC-US)?
-HPV testing (preferred) ---> if HPV + ---> Colposcopy --> manage per ASCCP guideline
-Repeat cytology (@1 yr acceptable) --> If more ASC ---> colposcopy --> manage per ASCCP guidelines
what is the next step in management of women with LSI with negative HPV OR no HPV test done OR with + HPV test?
gold standard for Dx and tx planning in cervical CA?
-must visualize entire squamocolumnar junction
-look for acetowhite changes, punctuations, mosaicism, abnormal vessels, masses (in order of severity of disease)
-directed biopsies and endocervical curettage
when are excisional techniques utilized for tx of cervical CA?
-endocervical curettage is postiive (needs cold knife cone)
-unsatisfactory colposcopy (No SCJ)
-substantial discrepancy between pap and biopsy (i.e., high grade pap and neg. colposcopy)
risks of excisional procedures?
-INCREASED RISK OF PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM)
-OPERATIVE RISKS-BLEEDING, INFX
-increased risk of cervical incompetence and resultant 2nd trimester pregnancy loss
91% of cervical CA is caused by HPV and 80% of cases are ___ carcinomas
-adenocarcinoma/adenosquamous make up 15%
for clinical evalulation of cervical neoplasia:
symptoms: watery vaginal bleeding, postcoital bleeding, intermittent spotting
spread: direct invasion and lymphatic spread
staged: clinically (PE, radiology-chest and skeletal xrays, IVP; cytoscopy; sigmoidoscopy, LFTs
how to prevent cervical CA?
-abstinence/limit # partners
-USE OF BARRIER PROTECTION
-regular exams and pap smears
-VACCINATION with THE HPV VACCINE
how is HPV vaccine administered? recommendation for who?
1st dose, 2nd dose 2 months later, 3rd dose 6 months from 1st
all girls and boys ages 9-26